COVID-19 and Asthma Control in Children

Introduction

The novel coronavirus disease (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), initiated as an epidemic in Wuhan, China, in December 2019 and transformed into an epidemic in March 2020. Those with chronic lung disease were apprehensive about acquiring COVID-19 and its aftereffects. In the initial stages of the pandemic, those with moderate-severe allergy or asthma were considered to be in the high-risk zone of acquiring severe COVID-19.

What Does Good Asthma Control Mean?

Good asthma control means:

• Having asthmatic symptoms for not more than two days a week.

• Using a reliever for not more than two days a week.

• There are no limitations or difficulties for an individual with asthma.

• Not experiencing any symptoms at night or when waking up in the morning.

Why Is the COVID-19 Virus Considered a Respiratory Virus?

SARS-CoV-2 is a contagious virus that can transfer from one person to another through respiratory droplets and gain entry into the human body through the nose and mouth. Infection with this virus causes respiratory issues like nasal congestion, cough, and difficulty breathing. Few cases may be associated with no symptoms or severe illness due to inflammation. The reason why the symptoms and severity differ with each person is not clear, but since it affects the respiratory system, it is considered a respiratory virus. Those with asthma can have numerous aggravating factors that can worsen the condition or cause persistent symptoms from long-term exposure. Respiratory viruses are the common triggering factors of asthma in children. A common cold can exacerbate and lead to difficulty breathing in children with asthma.

In What Way Is the COVID-19 Virus Different From Other Respiratory Viruses?

The COVID-19 virus differs from other respiratory viruses in the following ways:

• Fewer SARS-Cov-2 virus receptors in a few asthmatic individuals can decrease the binding and entry of the COVID-19 virus.

• Inhaled steroids, commonly recommended in asthmatic patients, can also decrease the SARS-CoV-2 virus receptors. Increased awareness about face masks has decreased children's flu and other respiratory infections.

• Research shows that asthmatic individuals who tested positive for COVID-19 infection did not become sick or required more hospitalizations than non-asthmatic individuals.

• This does not mean that asthmatic patients do not develop COVID-19 infection and must follow the safety protocols like others. They should also continue with their medications and regular follow-up with their doctor.

What Are the Symptoms of Asthma?

Symptoms of asthma are:

• Coughing, especially at night.

• Chest tightness, pain, or pressure.

• Shortness of breath.

• Wheezing (whistling sound while breathing).

Not all symptoms need to be present during each episode. For example, symptoms can vary with asthma attacks.

What Are the Effects of Vaccination Against the COVID-19 Virus in Asthmatic Kids?

About 70% of adults in the United States are completely vaccinated against the COVID-19 virus. Still, the Food and Drug Administration (FDA) approved the COVID-19 vaccine called the Pfizer-BioNTech in October 2021 for emergency use in children aged between 5 to 11. Though there is a push to authorize the wider use of vaccines in children, recent research shows that it can be critical to vaccinate kids with poorly controlled asthma.

A study shows that children with poorly controlled asthma have 3 to 6 times more chances of being hospitalized with COVID-19 than normal. Conversely, well-controlled asthmatic individuals have a comparatively lower risk of developing COVID-19 symptoms.

Can COVID-19 Pose a Risk to Children With Asthma?

The Centers for Disease Control and Prevention (CDC) has stated that individuals with moderate to severe asthma are at a higher risk of developing COVID-19 and can become seriously ill or be hospitalized. In addition, this interlink is more probable in non-allergic asthma than in allergic asthma. In the beginning stages of the COVID-19 pandemic, it was believed that asthmatic children are at a higher risk of acquiring COVID-19 infection, but recent research shows that the risk is less likely in children than in adults.

What Mechanism in Children Offers Them Protection Against the COVID-19 Virus?

A study conducted in 2021 shows that asthma in children offers protection against the COVID-19 virus in the following ways:

• Type 2 Immune Response: This acts by activating and regulating the cells that fight against harmful infections.

• Elevated Levels of Eosinophils: Eosinophils are a kind of white blood cells that fight against infections. They offer protection from respiratory viruses by releasing cytotoxic proteins and nitric oxide, producing type 1 cytokines (a protein produced by the immune and non-immune cells that act on the immune system), and employing cytotoxic T cells (immune cells that kill infected cells).

• Increased Mucus Production: Increased mucus production can offer protection from the COVID-19 virus by acting as a barrier and preventing their entry into the lungs.

• Asthma Control Treatment: Inhaled steroids can also help minimize the risk of acquiring COVID-19 infection.

What Are the Benefits of Vaccinating Asthmatic Children With the COVID-19 Vaccine?

Vaccination's primary benefit is minimizing the risk of infection and preventing its spread among people. The COVID-19 vaccine has also been found to offer this benefit. Vaccination in children with poorly controlled asthma can prevent it from becoming a serious, life-threatening condition. It could reduce the chance of infection and, in turn, minimize the risk of hospitalization and the spread of the disease.

Parents are reluctant to vaccinate their children because of the false information provided by various online and offline resources that this new vaccination may be associated with risks.

What to Do if a Child Has Symptoms of Asthma During COVID-19?

The following can be done if a child develops asthma during the pandemic:

• An asthma action plan given by the doctor should be kept handy and referred to when needed by the parents or caretakers.

• The asthma action plan will direct about everyday asthma care in kids and what must be done in case the symptoms develop.

• Management of asthma episodes should be managed the same way during the pandemic as in other situations.

• Oral steroids can be used if it is mentioned in the action plan.

• A pediatrician (child specialist) can be consulted in case the symptoms become severe or if the parent or the caretaker has other doubts.

• Avoid triggering factors that could aggravate asthma. Non-allergic asthma can be triggered by viral infections, air pollution, and increased physical activity.

What Is Contraindicated in Children With Asthma and COVID-19 Infection?

Systemic steroids (synthetic derivatives of natural steroids that have anti-inflammatory effects) given through veins (intravenous route) are contra-indicated since they can increase the shedding of the SARS-CoV-2 virus. However, inhaled steroids prescribed by the child specialist (pediatrician) can be used. Medications should only be stopped by consulting the doctor. Stopping the medications without the doctor's knowledge can exacerbate asthma symptoms and might require a visit to the hospital, increasing the chance of acquiring a COVID-19 infection in the child. Continuing the prescribed medication is the best way to prevent the trigger of asthma and avoid exposure to COVID-19.

Can the Parents Take Preventive Measures to Prevent Asthmatic Attacks During COVID-19?

The following preventive measures can be taken:

• Avoiding triggering factors like tobacco smoke, dust mites, air pollution, respiratory infections, pets, or mold.

• Educate the child to wash their hands regularly with soap and water or use a hand sanitizer that is alcohol-based.

• Avoiding crowded areas and refraining the children from getting close to people who are sick. It is also better to avoid unnecessary travel.

• A sick person at home can be isolated in a separate room to avoid spreading infection.

• Avoiding disinfectants that could trigger asthma.

• Use appropriate face masks or respirators, like N95 or KN95 models, to reduce the risk of infection from SARS-CoV-2.

• Ensure that the asthma action plan is up-to-date, and contact the doctor if any medication needs to be refilled. A Metered Dose Inhaler (MDI) technique with a spacer can be useful in delivering appropriate medication to the child's lungs and airways.

• Avoiding stress by taking the child for a walk and keeping them active.

• Children aged six months and above should get vaccinated for COVID-19 and flu, along with other regular immunizations.

When Is Emergency Care Required for a Child With Asthma?

A child may require emergency care if they have the following symptoms:

• Shortness of breath with difficulty speaking in full sentences.

• Difficulty in walking or running due to difficulty in breathing.

• Muscle movement between the ribs and abdomen is called belly breathing or the movement of muscles in the neck.

• Makes grunting noises, unresponsive to albuterol treatments, and bobbing of the head.

• The older child complains of tightness of the chest or chest pain while having difficulty breathing.

• Feeling confused or tired.

• The skin turns bluish or grayish around the mouth, chest, and middle of the face.

The child's asthma action plan will explain when to seek emergency help.

Conclusion

Studies show children with well-controlled asthma have fewer chances of acquiring or developing serious consequences from COVID-19 infection than those with poorly controlled asthma. The best way to prevent children and adults from developing flu, COVID-19, or other respiratory infections is to get vaccinated against the causative viruses.